NPI | 1508162827 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: CT 60421) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 268983) |
207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: CT 60421) | |
Enumeration Date | 2011-02-03 |
Last Update Date | 2018-05-31 |