| NPI | 1821320276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25ma08727300) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: HI md15520) |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2012-12-11 |