| NPI | 1457586893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 250428) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: MA 250428) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: MA 250428) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2025-05-20 |