| NPI | 1700178993 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA08927600) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A127894) |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2019-07-23 |