| NPI | 1023101250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 183732) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 75654) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-07-13 |