| NPI | 1538141080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 319849) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD431647) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2024-04-03 |