| NPI | 1033641287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 1023807) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ME MD24103) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2025-05-12 |