| NPI | 1356432652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 229933) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 229933-1) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2023-03-07 |