| NPI | 1821230236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: AL Md31618) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 208000000X Pediatrics (Licence: FL ME 123538) | |
| 208000000X Pediatrics (Licence: AL MD.31618) | |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2015-12-11 |