| NPI | 1619142569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ MA026165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA026165) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2008-04-22 |