| NPI | 1366401796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME135709) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ACN835) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: PR 8291) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2024-02-07 |