| NPI | 1255564266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD442411) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 255256) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2014-07-16 |