| NPI | 1477614618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI MD13305) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 236208) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2013-11-20 |