| NPI | 1841499365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A102364) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 252599) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2020-07-01 |