| NPI | 1376955591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: FL ME131355) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME131355) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2022-07-12 |