| NPI | 1073538567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 174749) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 174749) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2017-04-10 |