| NPI | 1720468408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 294447) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OT016663) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2018-07-09 |