| NPI | 1669432829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA10922400) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 237671) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: NY 237671) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2021-02-10 |