| NPI | 1982605333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD419267) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ ma72486) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2016-02-11 |