| NPI | 1104851195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: MI 4301101957) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 77458) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2015-01-15 |