| NPI | 1215936604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME174747) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA05108200) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2025-10-17 |