| NPI | 1306004544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA09461100) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children (Licence: PA MT188382) |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2020-02-21 |