| NPI | 1679637706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A65537) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 230633) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2024-04-10 |