| NPI | 1003828419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ME MD29779) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VT 0420010598) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2026-04-15 |