| NPI | 1306152400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: FL ME113139) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA08630900) |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2012-06-20 |