| NPI | 1730336991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D77152) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 250486) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2014-01-29 |