| NPI | 1760769095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 54847) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 277200) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2018-03-17 |