| NPI | 1255333050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 65632) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 198034) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2008-07-08 |