| NPI | 1194145946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 274166) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A185026) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: CA A185026) | |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2026-01-28 |