| NPI | 1255330999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD447565) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME0093163) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2017-02-01 |