| NPI | 1225396930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 280183) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 1017844) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2024-06-07 |