| NPI | 1417965302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 044499) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 237434) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2012-10-16 |