| NPI | 1275531568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 218036) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD070833L) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2016-04-01 |