| NPI | 1487734596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A100771) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 2371471) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2009-07-21 |