| NPI | 1780672832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA06847400) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: FL ME89901) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2022-05-05 |