| NPI | 1972570034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA04610800) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 147902) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2019-11-14 |