| NPI | 1891805909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA03901500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 137865) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |