| NPI | 1487640397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME124133) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 223250-1) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2023-03-07 |