| NPI | 1720307598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: FL ME116584) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME116584) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2026-01-14 |