| NPI | 1407181258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: CA 162621) |
| Additional Taxonomies | 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: NY 257167) |
| 208D00000X General Practice (Licence: NY 257167) | |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2020-03-09 |