| NPI | 1750948386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI MD18312) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP04503) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2022-03-14 |