| NPI | 1093716482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2009-00440) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 225335) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2013-03-11 |