| NPI | 1083902282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 20797) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME140051) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2023-03-07 |