| NPI | 1649677014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP60919974) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID O-1797) |
| 208000000X Pediatrics (Licence: CA 20A13699) | |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2023-05-17 |