| NPI | 1821394644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: WA MD61091599) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD61091599) |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2021-12-02 |