| NPI | 1588643837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MA 33281) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 33281) |
| Enumeration Date | 2006-01-14 |
| Last Update Date | 2007-07-08 |