| NPI | 1013137694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME0111708) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E-6152) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2016-04-28 |