| NPI | 1225021892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 201578) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 201578) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2014-10-23 |