| NPI | 1447887633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ME MD28090) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VT 042.0017113) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2024-08-01 |