| NPI | 1023019007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 238607) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI MD11827) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2012-01-13 |