| NPI | 1760694632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME107278) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57012382) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2016-08-26 |