| NPI | 1649406828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: WA MD60589263) |
| Additional Taxonomies | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: MD D0076097) |
| 208000000X Pediatrics (Licence: MO 2010012757) | |
| 208000000X Pediatrics (Licence: KS 94-07430) | |
| 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: WA MD60589263) | |
| 207P00000X Emergency Medicine (Licence: WA MD60589263) | |
| 208000000X Pediatrics (Licence: WA MD60589263) | |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2015-10-21 |