| NPI | 1831161827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA06288100) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 194601) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2021-02-08 |