| NPI | 1548400138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A128226) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 251256) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2024-04-16 |