Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 62862 | AZ |
N | 2080P0202X | Pediatric Cardiologist | 62862 | AZ |
Y | 2080P0203X | Pediatric Critical Care Doctor | 62862 | AZ |
NPI | 1043552870 |
---|---|
Provider Name | Mr. Christopher Sebastian Knoll |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2013 |
Last Update Date | 25/10/2021 |