| NPI | 1023006210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME56930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME56930) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2019-08-07 |