| NPI | 1124232822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME122523) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301086369) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2015-10-19 |