| NPI | 1902978059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME 120808) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 15958) |
| 208000000X Pediatrics (Licence: FL ME120808) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2023-08-09 |