| NPI | 1831176650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 175983) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NY 175983) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2022-10-20 |