| NPI | 1033476924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME111515) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME111515) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2024-09-18 |