| NPI | 1437311990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA MD.206279) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP01361) |
| 208000000X Pediatrics (Licence: PA MD441966) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2014-05-22 |