| NPI | 1164627584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME128702) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 26458) |
| Enumeration Date | 2007-06-16 |
| Last Update Date | 2017-03-28 |