| NPI | 1073812038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 60-260332) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: NY 60-260332) |
| 282NC2000X General Acute Care Hospital, Children (Licence: NY 60-260332) | |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2018-08-23 |