| NPI | 1063699163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2007024787) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 294252) |
| 207P00000X Emergency Medicine (Licence: NC 2013-01907) | |
| 207P00000X Emergency Medicine (Licence: MO 2014037017) | |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2014-10-31 |