| NPI | 1245420678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 244600) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA08302800) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2008-07-23 |