| NPI | 1346819091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA12356900) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT223920) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2024-09-19 |