NPI | 1194885731 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: NY 171226) |
Additional Taxonomies | 208D00000X General Practice (Licence: NY 171226) |
Enumeration Date | 2006-12-12 |
Last Update Date | 2007-07-08 |