| NPI | 1811199821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI LP01110) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 243278) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2022-09-23 |