| NPI | 1881805026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME 81215) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA02176200) |
| Enumeration Date | 2007-05-26 |
| Last Update Date | 2007-07-08 |