| NPI | 1215103023 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: CA A115958) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A115958) | 
| Enumeration Date | 2008-05-01 | 
| Last Update Date | 2013-04-22 |