| NPI | 1245500438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME165501) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL L.3512R) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2024-02-19 |