| NPI | 1235156993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 120387) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G32643) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |