| NPI | 1205030228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 235952) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 235952) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA C145084) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2019-05-22 |