| NPI | 1477711091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C169640) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 47298) |
| 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: KY 47298) | |
| 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: CA C169640) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2023-06-08 |