| NPI | 1023182557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 069944) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA03690600) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2013-08-16 |