| NPI | 1619142957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL OS-0003915) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL OS-0003915) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2008-04-28 |