| NPI | 1659558492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 244842) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C141416) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2026-05-01 |