| NPI | 1912630104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0214X Pediatrics, Pediatric Pulmonology (Licence: NY 337534) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 337534) |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2025-06-23 |