| NPI | 1437159878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 223838) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 223838) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2023-10-29 |