| NPI | 1275761371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 129572) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2012-01200) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2023-11-22 |