| NPI | 1700815685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME94236) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI MD09990) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2024-04-08 |