| NPI | 1760483473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME0022387) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 112800) |
| 208000000X Pediatrics (Licence: CA G26488) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2007-07-08 |