| NPI | 1912941071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 232896) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 232896) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2012-02-27 |