| NPI | 1689312837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.153297) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP05571) |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2025-06-16 |