| NPI | 1134421118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 236235) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA07716700) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2020-08-07 |