| NPI | 1598730376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD028322E) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 144861-1) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2021-04-30 |