| NPI | 1942223458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA08701100) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 237507) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2019-04-23 |