| NPI | 1164592333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA08924400) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA a94297) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2011-07-28 |