| NPI | 1578826889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MT202452) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA09633600) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2015-03-07 |