| NPI | 1568627073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 236077) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A116389) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2021-07-16 |