| NPI | 1215104583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MD D85295) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 003687) |
| 282NC2000X General Acute Care Hospital, Children (Licence: NY 003687) | |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2018-06-19 |