| NPI | 1457778383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME144985) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 40493) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2020-07-08 |