| NPI | 1710119771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME115138) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E6211) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME115138) | |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2014-04-18 |