| NPI | 1881785137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CT 66626) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NH 11630) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: MA 269024) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: ME MD17852) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-12-28 |