| NPI | 1326570078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ME MD23749) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NH 39978) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2026-07-23 |