| NPI | 1962406835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME132336) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0053131) |
| 208000000X Pediatrics (Licence: WV 21137) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2021-03-03 |