| NPI | 1871930065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P7729) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY FR0453669-101) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2017-10-19 |