| NPI | 1265883359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 300003) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME157771) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2025-09-18 |