| NPI | 1073608543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 242920) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A75880) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2026-08-07 |