| NPI | 1851338578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME102192) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO MD106192) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2015-07-08 |