| NPI | 1790043800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 279178) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 279148-1) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2024-12-20 |