| NPI | 1104802305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: FL ME93391) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME93391) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME93391) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2020-08-11 |