| NPI | 1659367001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 243178) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 191722) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2011-03-09 |