| NPI | 1386639011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 253273) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VT 0420010804) |
| 208000000X Pediatrics (Licence: MO 2006025651) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2009-08-25 |