| NPI | 1396835047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 232607) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 232607) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2013-05-20 |