| NPI | 1265844344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 1017559) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q4599) |
| 208000000X Pediatrics (Licence: RI MD19659) | |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2026-01-19 |