| NPI | 1437188125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME83433) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: FL ME83433) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2024-03-14 |