| NPI | 1396938478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 45605) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 248149) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2025-11-19 |