| NPI | 1013282581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60663357) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A135505) |
| Enumeration Date | 2012-03-16 |
| Last Update Date | 2020-10-07 |