| NPI | 1194946467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60765787) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C141414) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2022-06-29 |