| NPI | 1154436863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NJ MA033883000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA03883000) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2018-01-03 |