| NPI | 1881653723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME72652) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0072652) |
| 208000000X Pediatrics (Licence: FL ME0072652) | |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2021-10-27 |