| NPI | 1780024752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: KY TP019) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2016022188) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MO 2016022188) | |
| Enumeration Date | 2013-07-04 |
| Last Update Date | 2022-09-16 |