| NPI | 1457610875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: DC MD046009) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CT 57008) |
| 208000000X Pediatrics (Licence: CT 57008) | |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2018-09-14 |