| NPI | 1194802124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME90355) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME90355) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-11-07 |