| NPI | 1780653402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101239081) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 201046) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2007-07-08 |