| NPI | 1306296645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: MN 67677) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 5101022793) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2022-04-05 |