| NPI | 1104811512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME121818) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD417302) |
| 208M00000X Hospitalist (Licence: FL ME121818) | |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2020-09-01 |