| NPI | 1295870590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME5514) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME55114) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2021-04-14 |