| NPI | 1750510996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME153610) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: FL ME153610) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2025-10-06 |