| 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) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: KS 0539144) | |
| Enumeration Date | 2007-06-01 | 
| Last Update Date | 2025-06-03 |