| NPI | 1407163066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 23434) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME120237) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2023-04-05 |