| NPI | 1881662435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 94636) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME94636) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME 94636) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2020-12-27 |