| NPI | 1023322435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DE C10007060) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME130486) |
| 208D00000X General Practice (Licence: FL ME130486) | |
| 208000000X Pediatrics (Licence: PA MD417247) | |
| 208000000X Pediatrics (Licence: NJ 25MA10013400) | |
| 208000000X Pediatrics (Licence: MD D82978) | |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2017-03-13 |