NPI | 1609011873 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: NY 152640) |
Additional Taxonomies | 208D00000X General Practice (Licence: NY 152640) |
Enumeration Date | 2008-12-02 |
Last Update Date | 2008-12-02 |