| NPI | 1205053451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NY 003419) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: RI LP00820) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2009-07-22 |