| NPI | 1265069470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 319088-01) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA12384900) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2024-08-26 |