| NPI | 1063573111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 151386) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: NY 151386) |
| 208000000X Pediatrics (Licence: NY 151386) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-07-08 |