| NPI | 1699272567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 308910) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA11081300) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2024-09-26 |