| NPI | 1598085342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 47707) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 270177) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2023-11-27 |