| NPI | 1912901497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME47365) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME0047365) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2025-04-21 |