| NPI | 1649653494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: MI 4301115622) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125067744) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2018-07-05 |