| NPI | 1508125295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: AZ 60758) |
| Additional Taxonomies | 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: MO 2015030821) |
| 208000000X Pediatrics (Licence: MO 2015030821) | |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2022-01-12 |