| NPI | 1356684138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D89054) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 283808-01) |
| Enumeration Date | 2013-03-31 |
| Last Update Date | 2021-01-02 |