| NPI | 1386612869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME68890) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME0068890) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2021-03-11 |