| NPI | 1780613158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OS004639L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MB08055300) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2010-03-10 |