| NPI | 1851308605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 137850) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 137850) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2025-09-11 |