| NPI | 1013539055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VT 042.0017835) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04876) |
| 208000000X Pediatrics (Licence: NY 331199) | |
| 208000000X Pediatrics (Licence: RI LP04876) | |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2024-06-28 |