| NPI | 1871560409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NJ 25MA10844000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA10844000) |
| 208000000X Pediatrics (Licence: CT 046079) | |
| 208000000X Pediatrics (Licence: NJ 25MA10844000) | |
| 208D00000X General Practice (Licence: MA 223798) | |
| 282NC2000X General Acute Care Hospital, Children (Licence: NY 257559-1) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2024-05-02 |