| NPI | 1255319604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 212832) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NH 17197) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2023-10-27 |