| NPI | 1356637292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 1505) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20A13236) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2023-06-21 |