| NPI | 1508043001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 80808) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 80808) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2021-03-09 |