| NPI | 1760049522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MA 1023840) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP04604) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2025-06-02 |