| NPI | 1922528728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 300803) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: CO DR.0070256) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2025-09-08 |