| NPI | 1043275159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 141577) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 141577) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2012-03-29 |