| NPI | 1396175931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD206456) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA a124552) |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2021-09-23 |