| NPI | 1871533547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME110221) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D54679) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2025-08-12 |