| NPI | 1497829865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 115372) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 115372) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2008-10-22 |