| NPI | 1811258874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 56293) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI LP02640) |
| 208000000X Pediatrics (Licence: NY 279712-1) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2023-02-13 |