| NPI | 1316104730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 264739) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI DO00684) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2026-05-06 |