| NPI | 1861805681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 260731) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI MD18652) |
| 208000000X Pediatrics (Licence: MA 270821) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2022-10-21 |