| NPI | 1083680342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 045563) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 230823) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2016-02-11 |