| NPI | 1063501591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: MI 4301056997) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MI 4301056997) |
| 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: MI 4301056997) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2018-03-17 |