| NPI | 1649257916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 20051) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 20051) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2023-04-28 |