| NPI | 1669731394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME122561) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME122561) |
| 208000000X Pediatrics (Licence: NJ 25MA09039000) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: NJ 25MA09039000) | |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2021-02-03 |