| NPI | 1952594483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: FL ME106887) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00882100) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2010-06-16 |