| NPI | 1346205192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 298646) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD039346E) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2024-12-13 |