| NPI | 1538253604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 30827) |
| Additional Taxonomies | 171W00000X Contractor (Licence: MA 30827) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-03-29 |