| NPI | 1619924255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA 28635) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 28635) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2019-09-30 |