| NPI | 1235283938 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA02465100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA02465100) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2011-01-19 |