| NPI | 1669634648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 238993) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: NY 238993) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2024-10-09 |