| NPI | 1134195514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME97380) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA05878600) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2012-11-08 |