| NPI | 1730278433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME164632) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 121063) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-10-06 |