| NPI | 1609974740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI MD19578) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 224827) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-12-14 |