| NPI | 1225089923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NJ 25ma02760500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25ma02760500) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NJ 25ma02760500) | |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: NJ 25ma02760500) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2020-08-07 |