| NPI | 1669549309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA08167500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 242160) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2013-03-08 |