| NPI | 1558621748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 277318) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 72180) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2026-03-10 |