| NPI | 1831459874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 312909) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD16643) |
| 207R00000X Internal Medicine (Licence: RI LP02555) | |
| 207R00000X Internal Medicine (Licence: MD D0082449) | |
| 208000000X Pediatrics (Licence: RI MD16643) | |
| 208000000X Pediatrics (Licence: MD D0082449) | |
| 208000000X Pediatrics (Licence: RI LP02555) | |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2022-04-29 |