| NPI | 1013178433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME 123976) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101246006) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2018-12-24 |