| NPI | 1083683361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME125419) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 147485) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2018-02-05 |