| NPI | 1265463772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME99191) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.087677) |
| 208000000X Pediatrics (Licence: FL ME99191) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2013-02-07 |