| NPI | 1578641452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: VT 042.0017601) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: DC MD30338) |
| 207P00000X Emergency Medicine (Licence: VT 042.0017601) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NY 195776) | |
| 207P00000X Emergency Medicine (Licence: NY 195776) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-11-12 |