| NPI | 1679787154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 254821) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 254821) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-10-12 |