| NPI | 1194796201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 61338711205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A061998) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2021-11-11 |