| NPI | 1326201690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA09745800) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C10008738) |
| 208000000X Pediatrics (Licence: DE TP0003488) | |
| 208000000X Pediatrics (Licence: MD D67963) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2020-03-04 |