| NPI | 1568546471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME0056607) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0056607) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-04-02 |