| NPI | 1245367440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME131272) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY NY143693) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2019-10-07 |