| NPI | 1740289131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 221122) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA md070587l) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2023-03-07 |