| NPI | 1326402488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ME do3227) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 299213-1) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2021-08-09 |