| NPI | 1003264581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ R75756) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R75756) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2022-06-09 |