| NPI | 1902894884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME132502) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101230639) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2020-03-10 |