| NPI | 1629432687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD480743) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME141032) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2023-08-30 |