| NPI | 1285792978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101245096) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 1892751) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2011-06-07 |