| NPI | 1801000914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME98585) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME98585) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2016-04-26 |