| NPI | 1851737001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 275114) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0076096) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2020-06-03 |