| NPI | 1558358143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME99856) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: IL 036112828) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: WI 31212) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2008-02-01 |