| NPI | 1346702446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 1014394) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 315330) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2023-07-11 |