| NPI | 1821663824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI MD19779) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 1021927) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2025-04-03 |