| 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 |