| NPI | 1912091547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME124030) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 065043) |
| 208000000X Pediatrics (Licence: NY 200738) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-07-21 |