| NPI | 1710917679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: FL ME111404) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME0085813) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2024-06-20 |