| NPI | 1043672835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME146697) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A161617) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-10-29 |