| NPI | 1023090800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 65705) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME44927) |
| 208M00000X Hospitalist (Licence: FL 44927) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2025-07-23 |