| NPI | 1427286145 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OK 44212) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA08563900) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2025-02-10 |