| NPI | 1184619934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME63583) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME63583) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2017-11-28 |