| NPI | 1063458776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 016264) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD016264) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TN MD016264) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2007-07-08 |