| NPI | 1114952819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME55464) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL ME55464) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-08-13 |