| NPI | 1891751814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME141106) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-077589N) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2023-11-27 |