| NPI | 1851829295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MB11982700) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OT017988) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2024-05-17 |