| NPI | 1366007742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 280406) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 316658) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2022-06-23 |