| NPI | 1922493600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME143237) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 63442) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2022-01-17 |