| NPI | 1902244593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA09855500) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT203894) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2020-12-15 |