| NPI | 1083754972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: NV 9357) |
| Additional Taxonomies | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: CO CDR.0000632) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2025-08-12 |