| NPI | 1578051868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 286718) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA11856400) |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2023-05-16 |