| NPI | 1780672717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 185997) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME68149) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2012-12-14 |