| NPI | 1649777533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: WA 61650473) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0091516) |
| 208000000X Pediatrics (Licence: DC MD210001730) | |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2025-06-29 |