| NPI | 1104821081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME51571) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME51571) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2017-03-29 |