| NPI | 1265759831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 82146) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 267976) |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2022-05-20 |