| NPI | 1518346063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA10289200) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT208886) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2018-03-21 |