| NPI | 1033244645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME105288) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA08091100) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2024-04-11 |