| NPI | 1396768123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: TX Q6450) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME55957) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME55957) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2016-01-24 |