| NPI | 1356423222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 219794-1) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 219794-1) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2017-01-09 |