| NPI | 1629430798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA10676300) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL MD.38597) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2021-08-14 |