| NPI | 1023089406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME68237) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0068237) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-04-13 |