| NPI | 1649269689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME161851) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 193354) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2023-12-28 |