| NPI | 1811057193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 131829) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 131829) |
| 208000000X Pediatrics (Licence: DE C1-0002870) | |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2019-03-21 |