| NPI | 1801060843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME 119989) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 55507) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2016-04-20 |