| NPI | 1760639793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NY 249458) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 249458) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2013-09-30 |