| NPI | 1679737761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101244499) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT192780) |
| 208000000X Pediatrics (Licence: NJ 25MA08429900) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2019-02-05 |