| NPI | 1134515687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME146403) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 294636-1) |
| Enumeration Date | 2015-04-11 |
| Last Update Date | 2021-05-21 |