| NPI | 1003256421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301110841) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GU M-1987) |
| 208000000X Pediatrics (Licence: CA A144270) | |
| Enumeration Date | 2013-06-29 |
| Last Update Date | 2016-09-14 |