| NPI | 1982639126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME22185) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME22185) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2015-08-26 |