| NPI | 1376519553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME111013) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME111013) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2023-04-26 |