| NPI | 1184739666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME106195) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 125799-1) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2014-04-23 |