| NPI | 1053774968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME145500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA10657000) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2020-08-06 |