| NPI | 1316910508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD009687E) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 168735-1) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2007-07-08 |