| NPI | 1659529063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282NC2000X General Acute Care Hospital, Children (Licence: NY 262547-1) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: FL ME116587) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2021-03-24 |