| NPI | 1336102904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 85346) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 187312) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2023-12-20 |