| NPI | 1558460527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA05425700) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 305130-01) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-06-22 |