| NPI | 1730127556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: DC MD044625) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 141182) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2016-11-01 |