| NPI | 1174641336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: NY 114229) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 114229) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-08 |