| NPI | 1740290162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2018-00935) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 228253-1) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2023-08-31 |