| NPI | 1528175361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 155177) |
| Additional Taxonomies | 207ZB0001X Pathology Blood Banking & Transfusion Medicine (Licence: NY 155177-1) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2019-02-28 |