| NPI | 1164514154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ MA01724600) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD007176E) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2011-12-28 |