| NPI | 1790785004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: MO 2015031842) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: IA 36604) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2022-10-05 |