| NPI | 1710955240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 46053) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 142390) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2010-04-22 |