| NPI | 1851367411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D0063929) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 141212-1) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2015-12-17 |