| NPI | 1073965687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA10560700) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD467904) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2023-08-25 |