| NPI | 1396988069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61352935) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA AFE113787) |
| 208000000X Pediatrics (Licence: DE C1-0010229) | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2024-01-05 |