| NPI | 1235202292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME157270) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME157270) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2026-03-23 |