| NPI | 1033154570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25ma04003700) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 145846) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2012-04-23 |