| NPI | 1982792396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME170534) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A78371) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2025-03-04 |