| NPI | 1871800664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME108115) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL me108115) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME108115) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME108115) | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2025-09-12 |