| NPI | 1740453471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MB08355000) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: NJ 25MB08355000) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2025-06-02 |