| NPI | 1013443100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA12430000) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101270299) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2025-06-03 |