| NPI | 1598777633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI 11947) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G062233) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2016-04-28 |