| NPI | 1255906251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: PA MD484524) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD484524) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2025-03-05 |