| NPI | 1326018623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 73322) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ME MD17759) |
| 208000000X Pediatrics (Licence: NC 9900158) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2023-04-04 |