| NPI | 1235118845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ME 016163) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NH 20720) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2024-12-17 |