| NPI | 1417953720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD068622L) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME146146) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2022-03-25 |