| NPI | 1497315394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 320049) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL82813) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2023-01-30 |