| NPI | 1114144177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME140976) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD430046) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2023-04-18 |