| NPI | 1417185125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 82186) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2017-00720) |
| 207P00000X Emergency Medicine (Licence: SC 37826) | |
| 208000000X Pediatrics (Licence: KS 7288) | |
| 208000000X Pediatrics (Licence: NC 2017-00720) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NC 2017-00720) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2025-08-06 |