| NPI | 1992764617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: PR 9992) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 9992) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2007-07-08 |