| NPI | 1922360619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AK 119197) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R73235) |
| 208000000X Pediatrics (Licence: AZ R73235) | |
| 208000000X Pediatrics (Licence: AK 119197) | |
| Enumeration Date | 2012-06-09 |
| Last Update Date | 2022-08-10 |