| NPI | 1508941055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 130202) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 159930) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2021-12-22 |