| NPI | 1578910147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI MD17120) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 300226) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2025-06-24 |