| NPI | 1699749507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MN 43960) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 43960) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2020-10-07 |