| NPI | 1588741037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME0061139) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036-076516) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2011-11-14 |