| NPI | 1194875351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA 431500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 220184) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2013-04-18 |