| NPI | 1386611937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics Neonatal-Perinatal Medicine (Licence: NY 204514) |
| Additional Taxonomies | 174400000X Specialist |
| 208000000X Pediatrics (Licence: NY 204514) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2013-03-26 |