| NPI | 1215932207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301065883) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C144504) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2024-04-19 |