| NPI | 1063408540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 089973) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 89973) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2009-08-04 |