| NPI | 1952319352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA09423200) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-099737) |
| 208000000X Pediatrics (Licence: NY 262836) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2015-12-07 |