| NPI | 1790979615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: LA DO.000167) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 0000002125) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: TN 0000002125) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2021-05-21 |