| NPI | 1306223730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A153424) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301108055) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2018-09-26 |