| NPI | 1972899425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: NJ 25MA09541800) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 261910) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2017-03-20 |