| NPI | 1487658332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C55903) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101230079) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2016-05-19 |