| NPI | 1205153020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA07882100) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VT 42-0009397) |
| 208000000X Pediatrics (Licence: MD D30788) | |
| 208000000X Pediatrics (Licence: PA MD-028632-E) | |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2010-05-04 |