| NPI | 1326466921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 29034901) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 59171) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2022-04-11 |