| NPI | 1578550695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 49047) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 49047) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2023-04-24 |