| NPI | 1992789838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WV 21538) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 21538) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2021-12-01 |