| NPI | 1235240458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C166987) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL 23189) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-06-11 |