| NPI | 1205121118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: TN DO2921) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OT014062) |
| 208000000X Pediatrics (Licence: TN DO0000002921) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2022-03-31 |