| NPI | 1053456723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: MI 4301092413) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 49565) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2009-06-16 |