| NPI | 1952438301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 239603) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI MD14783) |
| 208000000X Pediatrics (Licence: MT 40019) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2021-12-07 |