| NPI | 1053670711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME127416) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL 17207) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2016-08-17 |