| NPI | 1629066980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME 0042195) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME 0042195) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2011-02-14 |