| NPI | 1801453865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 304529-01) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME144094) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2025-02-11 |