| NPI | 1083683924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA06193600) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ MA061936) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2026-02-17 |