| NPI | 1487648796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 145635) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM 93244) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2017-01-18 |