| NPI | 1568452233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD424573) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA07888000) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2016-03-10 |