| NPI | 1841394871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME0073654) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME0073654) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2016-04-18 |