| NPI | 1578790440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 251095) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 047774) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2018-03-17 |