| NPI | 1528447752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD466575) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 292601) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2020-08-27 |