| NPI | 1295764926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A101360) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 40990) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2021-12-13 |