| NPI | 1952389793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D0082579) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 174803) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2020-03-10 |