| NPI | 1679623839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CT 047588) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 230856) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2009-06-22 |