| NPI | 1396240107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: NY 334638) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 286931) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2025-10-24 |