| NPI | 1558307579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA02776000) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD019259Y) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2007-07-08 |