| NPI | 1801112768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: UT 7675577-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 243918) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2023-07-18 |