| NPI | 1295786978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 87253) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 223318) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2022-05-31 |