| NPI | 1407848575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA03777100) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NJ MA037771) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2024-09-27 |