| NPI | 1598770182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME0055642) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME0055642) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2025-06-02 |