| NPI | 1023543386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2023-01351) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 40849) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NC 2023-01351) | |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2023-10-23 |