| NPI | 1922104140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 16180) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME0062655) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2015-12-15 |