| NPI | 1154763720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A160052) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 18898) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2020-04-13 |