| NPI | 1487945945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 78615) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: GA 78615) |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2025-03-13 |