| NPI | 1285127415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 287823) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 275681) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2021-08-24 |