| NPI | 1508838871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 232292) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 86636) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2021-10-18 |