| NPI | 1982762167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA02767400) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA02767400) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2019-01-04 |