| NPI | 1962466813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 197158) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NY 197158) |
| Enumeration Date | 2006-04-16 |
| Last Update Date | 2012-04-27 |