| NPI | 1295864551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: PA md429111) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NJ 25ma05797300) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-08 |