| NPI | 1013413293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 317342-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 317342-01) |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2026-09-26 |