| NPI | 1932301066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: MO 2005023738) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34009039) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 34009039) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2023-01-09 |