| NPI | 1497781561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A91416) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME130710) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2021-11-29 |