| NPI | 1750427126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 162520) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD050951L) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2016-09-08 |