| NPI | 1972967461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2021036239) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: PA MD472792) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2021-12-01 |