| NPI | 1265495659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2022-01788) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI MD09704) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2022-09-12 |