| NPI | 1629307525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD441187) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA08892700) |
| Enumeration Date | 2009-12-24 |
| Last Update Date | 2018-11-26 |