| NPI | 1265762934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 102272-1) |
| Additional Taxonomies | 2080H0002X Pediatrics, Hospice and Palliative Medicine (Licence: NY 102272-1) |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2009-12-31 |