| NPI | 1275938482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 281405) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2016-04-05 |