| NPI | 1093343188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 25ma11798300) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25ma11798300) |
| 208000000X Pediatrics (Licence: NY 327924) | |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2024-07-19 |