| NPI | 1093911661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A104933) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD431475) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2015-06-25 |