| NPI | 1689937849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: FL ME110294) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME110294) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2015-06-18 |