| NPI | 1528068830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA06830300) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 219512) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NJ 25MA06830300) | |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NY 219512) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2007-07-11 |