| NPI | 1366424319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2007-01697) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NC 2007-01697) |
| 208000000X Pediatrics (Licence: NY 1589601) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NY 1589601) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2015-12-28 |