| NPI | 1144601907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME141202) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 38509) |
| 208000000X Pediatrics (Licence: SC 38509) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2020-10-21 |