| NPI | 1619499563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 330215) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 22288) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2024-12-13 |