| NPI | 1710322383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME140238) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM MD2018-0150) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2022-04-07 |