| NPI | 1134149230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NJ 25MA02744100) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA02744100) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 118888-1) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2022-01-24 |