| NPI | 1205367539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA13047400) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A169840) |
| 208000000X Pediatrics (Licence: NY 332507) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2026-06-24 |