| NPI | 1942273388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 158497) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA05145000) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2016-11-18 |