| NPI | 1962409037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NJ MA08710700) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: OH 35048098) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: PA MD013629E) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2016-04-22 |