| NPI | 1669451282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME137061) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-07-3961-S) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2025-04-16 |