| NPI | 1144590415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD H73666) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 228569) |
| 208000000X Pediatrics (Licence: NY 228569) | |
| 208000000X Pediatrics (Licence: MD H73666) | |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2012-05-15 |