| NPI | 1669887139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME131759) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX U5058) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2025-02-25 |