| NPI | 1326049529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207QA0000X Family Medicine Adolescent Medicine (Licence: NY 140363) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 140363) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2007-07-08 |