| NPI | 1760694673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 238776) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA10597300) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-12-07 |