| NPI | 1942543616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 271513) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 55278) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2022-07-21 |