| NPI | 1306473293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 1013872) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 327775) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2024-02-06 |