| NPI | 1316400153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME168568) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.144967) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2024-08-08 |