| NPI | 1104060102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NJ 25MA09761800) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: FL ME128883) |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2022-10-24 |