| NPI | 1558672220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 47458) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R72201) |
| 208000000X Pediatrics (Licence: AZ R72201) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2015-06-02 |