| NPI | 1508885120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 285497) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 285497) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-07-17 |