| NPI | 1215019641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A46669) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NJ 25MA05800100) |
| 208D00000X General Practice (Licence: NV 14165) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2017-10-10 |