| NPI | 1215249362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P6514) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GU MTL-2018-009) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2018-02-15 |