| NPI | 1487945945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL MD.33337) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 173240) |
| 208000000X Pediatrics (Licence: AL MD.33337) | |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2015-12-11 |