| NPI | 1780645374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA05988200) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ MA059882) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2013-11-18 |