| NPI | 1962659953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA08329600) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: NJ 25MA08329600) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2020-09-04 |