| NPI | 1104884410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME133640) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 181721) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2021-10-26 |