| NPI | 1124223722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101287607) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA083602) |
| 208000000X Pediatrics (Licence: PA MD448187) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2025-11-28 |