| NPI | 1689659302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: NY 219130) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 219130) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2018-12-27 |