| NPI | 1558556530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G56818) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV 26040) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2024-11-01 |