| NPI | 1104359405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 323750) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 67425) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NY 323750) | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2024-05-16 |