| NPI | 1124194980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME129312) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G57608) |
| 208D00000X General Practice (Licence: FL ME129312) | |
| 208D00000X General Practice (Licence: CA G57608) | |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2018-03-21 |