| NPI | 1225205222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MAA03771700) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 128333) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2008-05-09 |