| NPI | 1164569091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G86941) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME66931) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2021-03-29 |