| NPI | 1922635812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 323857) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 323857) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2025-01-03 |