| NPI | 1649256421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX J7108) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX J7108) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2018-03-17 |