| NPI | 1912214776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME161238) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME161238) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2026-06-17 |