| NPI | 1558663351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 174756) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 174756-1) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2010-11-30 |