| NPI | 1629481643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 270481) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 270481) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2022-03-22 |