| NPI | 1538521307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101288276) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME140404) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME140404) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2026-04-07 |