| NPI | 1720010127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME 92812) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME92812) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-04-15 |