| NPI | 1518127133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA10121200) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 248844) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2018-03-17 |