| NPI | 1164454542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: GA 70417) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 017865) |
| 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: LA 017865) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-07-15 |