| NPI | 1417280579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA09414200) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME113698) |
| 208D00000X General Practice (Licence: FL ME113698) | |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2025-10-08 |