| NPI | 1659631604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: PA MD477773) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD15352) |
| 207R00000X Internal Medicine (Licence: RI LP02546) | |
| 208000000X Pediatrics (Licence: RI MD15352) | |
| 208000000X Pediatrics (Licence: MA 270311) | |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2022-11-20 |