| NPI | 1932370681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME102793) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.006511) |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2024-06-27 |