| NPI | 1962677864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: WI 55790) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2006036873) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2012-12-19 |