| NPI | 1699749291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 129909) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 026928) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2013-10-21 |