| NPI | 1346291010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: WI 45697) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MN 48531) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: MN 48531) | |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: WI 45697) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2014-10-21 |