| NPI | 1235358656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA03456400) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NJ 25MA03456400) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2014-01-06 |