| NPI | 1114212404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI MD15915) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: RI 15915) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2017-12-13 |