| NPI | 1306139332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 293722) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 293722) |
| 208000000X Pediatrics (Licence: PA OS017574) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2023-12-15 |