| NPI | 1396274908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 287443) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125070910) |
| 208000000X Pediatrics (Licence: IL 125070910) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 287443) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2023-04-19 |