| NPI | 1770549289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 213571-1) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ MA 068417) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2023-07-25 |