| NPI | 1912901455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL ME92476) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 33103) |
| 208000000X Pediatrics (Licence: PA MD429183) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2011-08-03 |