| NPI | 1609053552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 238920) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI MD13917) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2024-05-03 |