| NPI | 1598862807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 209352) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 209352) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-07-11 |