| NPI | 1346829389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 1024537) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 334129) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2025-06-19 |