| NPI | 1093759003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: NJ 25MA03209300) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA03209300) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2025-03-17 |