| NPI | 1184679151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME76442) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0076442) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2014-02-14 |