| NPI | 1457937047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 332047) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL 176801) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: FL 176801) | |
| 208000000X Pediatrics (Licence: FL 176801) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: NY 332047) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NY 332047) | |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2026-05-21 |