| NPI | 1851487292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME125625) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA07864200) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2018-04-17 |