| NPI | 1841284080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA11780900) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 191470) |
| 208000000X Pediatrics (Licence: MA 270781) | |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2023-06-28 |