| NPI | 1457458176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 207307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 207307) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2025-09-19 |