| NPI | 1811139710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA09055300) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD444659) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2020-10-29 |