| NPI | 1396083630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME130063) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS 22828) |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2022-07-21 |