| NPI | 1861428880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NJ ma41374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ ma41374) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2022-11-19 |