| NPI | 1386820215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: PA MD436745) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA08336600) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2019-02-28 |