| NPI | 1932410172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2013-00600) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MB09535900) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2020-06-18 |