| NPI | 1629480173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: LA 322365) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 322365) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2020-08-19 |