| NPI | 1639164379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 174922) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 174922) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2021-09-09 |