| 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 |