| NPI | 1780648295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2006-01305) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA07719500) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2007-07-08 |