| NPI | 1265526602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME85143) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME85143) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-05-21 |