| NPI | 1801843297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX 2663) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NJ 25MA0066859) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2024-04-15 |