| NPI | 1235235516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA04200800) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ MA42008) |
| 208000000X Pediatrics (Licence: PA MD-011644-E) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2019-07-10 |