| NPI | 1124123195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME149464) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C54560) |
| 208000000X Pediatrics (Licence: AL 20711) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2021-09-02 |