| NPI | 1124110226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA05955400) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ MA059554) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2024-05-25 |