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 |