| NPI | 1912939695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME61466) |
| Additional Taxonomies | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: FL ME0061466) |
| 208000000X Pediatrics (Licence: FL ME0061466) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME61466) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2024-08-29 |