| NPI | 1063510014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ ma 63401) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA06340100) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-03-10 |