| NPI | 1013978949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 101721) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME111599) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2012-11-05 |