| NPI | 1124285788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA08647000) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD027273E) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2012-12-07 |