| NPI | 1326573445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME170700) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.139870) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2024-11-08 |