| NPI | 1801896220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: DC MD046853) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: TN 30231) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2019-02-21 |