| NPI | 1114017811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME152727) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 226312) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2023-09-14 |