| NPI | 1720281785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD61404786) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 3980) |
| 207P00000X Emergency Medicine (Licence: IN 01092842A) | |
| 207P00000X Emergency Medicine (Licence: OH 35.099340) | |
| 208000000X Pediatrics (Licence: OH 35.099340) | |
| 208000000X Pediatrics (Licence: IN 01092842A) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2024-04-22 |