| NPI | 1134128101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX M7173) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 220389) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2020-10-16 |