NPI | 1891979241 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME111500) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 245919) |
Enumeration Date | 2007-12-20 |
Last Update Date | 2025-09-12 |