| NPI | 1578658720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: NJ 25MA05478100) |
| Additional Taxonomies | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: NJ MA54781) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2021-07-23 |