| NPI | 1457871006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: MO 2020012908) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2020012908) |
| Enumeration Date | 2017-06-25 |
| Last Update Date | 2020-07-02 |