| NPI | 1700311917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA12306500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 305248) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: NY 305248) | |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2025-02-05 |