| NPI | 1326365982 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NJ 25MA09965700)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD449408)  | 
| Enumeration Date | 2010-04-22 | 
| Last Update Date | 2018-05-31 |