| NPI | 1215961172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME 53457) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL 53457) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2017-01-24 |