NPI | 1508803289 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: MN 79992) |
Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: OH 35064164) |
207P00000X Emergency Medicine (Licence: TX N4706) | |
207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: TX N4706) | |
Enumeration Date | 2006-06-01 |
Last Update Date | 2025-06-26 |