| NPI | 1184944910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI MD17564) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP02010) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2021-04-09 |