| NPI | 1528070752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD190026) |
| Additional Taxonomies | 2080A0000X Pediatrics Adolescent Medicine (Licence: CA C37164) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2021-07-15 |