| NPI | 1740261510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 159589) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 265617) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2012-09-18 |