| NPI | 1821042037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CT 52507) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: RI 08791) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2013-10-03 |