| NPI | 1952397887 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME64987) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME64987) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2012-07-11 |