| NPI | 1194851063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA C146978) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 25492) |
| 208000000X Pediatrics (Licence: DC MD034443) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 180846) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: MD D0059017) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2018-06-21 |