| NPI | 1215015821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 29526) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME0069280) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-09-10 |