| NPI | 1154686236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: PR 21580) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 279494) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2021-01-27 |