| NPI | 1710128558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: CA A106486) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: NY 250559) |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2009-10-27 |