| NPI | 1326289711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A110252) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 249694) |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2021-11-22 |