| NPI | 1831256882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ MA074267) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME 125918) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2016-01-12 |