| NPI | 1831432590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 274922) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD449941) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2023-09-15 |