| NPI | 1104894708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ME 013589) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NH 13509) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2007-10-27 |