| NPI | 1477555340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL OS2488) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MB07336500) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2021-05-05 |