| NPI | 1558548255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A103298) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 23415) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2008-04-08 |