| NPI | 1154432276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA05950700) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NJ ma057052) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-05-22 |