| NPI | 1962607911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: UT 7569499-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 50866) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2021-12-14 |