| NPI | 1336408723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 273768) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI MD16109) |
| 208000000X Pediatrics (Licence: NH 18714) | |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2023-02-22 |