| NPI | 1457490963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 170828) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 170828) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2021-07-28 |