| NPI | 1669481198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C175630) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301063254) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2023-05-24 |