| NPI | 1134119811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NJ MA06375700) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ MA06375700) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2021-01-22 |