| NPI | 1023250727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 239067) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 249827) |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2013-05-29 |