| NPI | 1114907730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA07276300) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA07276300) |
| 208000000X Pediatrics (Licence: NY 204950) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2021-02-12 |