| NPI | 1154345031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NV 7487) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G75292) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2018-02-27 |