| NPI | 1386069235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 252601) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NY 252601) |
| 208D00000X General Practice (Licence: NY 252601) | |
| Enumeration Date | 2014-03-02 |
| Last Update Date | 2014-11-07 |