| NPI | 1629638721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NY 316857) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 316857) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2026-06-05 |