| NPI | 1033504766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MB11061600) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 292383) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2023-11-17 |