| NPI | 1780143032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME155693) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 317474) |
| 208000000X Pediatrics (Licence: FL TRN28170) | |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2024-07-21 |