| NPI | 1972949022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: SC 88970) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2016-01402) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2022-12-13 |