| NPI | 1003016569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD434681) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA08590200) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2020-10-09 |