| NPI | 1285795526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C54961) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL 27735) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2021-12-06 |