| NPI | 1730400821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 390200000x) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA10588300) |
| Enumeration Date | 2010-06-13 |
| Last Update Date | 2025-12-29 |