| NPI | 1821695891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 10197) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ NJDCATEMP-000638) |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2024-09-19 |