| NPI | 1639113285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DE C1-0008136) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: PA MD429242) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MD D0064698) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: LA 15427R) | |
| 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: LA 15427R) | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: LA 15427R) | |
| 208M00000X Hospitalist (Licence: MD D0064698) | |
| 208000000X Pediatrics (Licence: MD D0064698) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: LA 15427R) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: DE C1-0008136) | |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: DE C1-0008136) | |
| 2080P0207X Pediatrics, Pediatric Hematology-Oncology (Licence: MD D0064698) | |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: LA 15427R) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: LA 15427R) | |
| 208000000X Pediatrics (Licence: LA 15427R) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2025-12-12 |