| NPI | 1679077432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA12787000) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DC MD210001952) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2025-07-21 |