| NPI | 1679581458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 62224) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD0681761) |
| 208000000X Pediatrics (Licence: NJ 25MA06940000) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2021-06-01 |