| NPI | 1104801174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 128561) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 018597) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2008-07-24 |