| NPI | 1861647349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: WA MD60453029) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301092617) |
| 208000000X Pediatrics (Licence: WA MD60453029) | |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2014-07-22 |