| NPI | 1699037036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: MA 274643) |
| Additional Taxonomies | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: RI MD14958) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2018-06-19 |