| NPI | 1114319324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NJ 25MA10545700) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101259983) |
| 208000000X Pediatrics (Licence: NJ 25MA10545700) | |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2024-05-02 |