| NPI | 1023344660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C169016) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 46557) |
| Enumeration Date | 2009-11-01 |
| Last Update Date | 2020-08-14 |