| NPI | 1548289523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 170604) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 47033) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2013-07-19 |