| NPI | 1619297975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 275225) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA12026800) |
| 208000000X Pediatrics (Licence: FL ME116606) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2026-03-17 |