| NPI | 1245282060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME142493) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 147727) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2019-12-26 |