| NPI | 1649280041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME0026524) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2012-00665) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2019-10-16 |