| NPI | 1093871881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 20A9847) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 238599) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2021-12-16 |