| NPI | 1689638157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME50234) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: FL ME50234) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME50234) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2026-08-26 |