| NPI | 1437135951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA08353000) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 200150) |
| 208000000X Pediatrics (Licence: VA 0101239770) | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2008-03-27 |