| NPI | 1134457583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 254688) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD438211) |
| 208000000X Pediatrics (Licence: CA A105707) | |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2021-03-18 |