| 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 |