| NPI | 1801389655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 287972) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP04355) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2026-01-17 |