| NPI | 1528138740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI MD19137) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2017-00831) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2023-04-14 |