| NPI | 1740631001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: IA DO-05211) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-10704) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2023-05-19 |