| NPI | 1104905850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G70304) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G70304) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2019-09-13 |