| NPI | 1518114149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ME MD20138) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT193169) |
| 208000000X Pediatrics (Licence: PA MD442713) | |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2014-06-04 |