| NPI | 1528446358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA OS017639) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 20A12186) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2020-08-30 |