| NPI | 1346250362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA G5928) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ MA69791) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2022-01-07 |