| NPI | 1033143441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME91037) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA12281700) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2024-07-17 |