| NPI | 1508897265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G134469) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 00150521) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2018-07-05 |