| NPI | 1154365369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD177926) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 206363) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2016-08-27 |