| NPI | 1477549848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2017-00135) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME47806) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2025-12-16 |