| NPI | 1679864912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA c191507) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 62546-20) |
| 208000000X Pediatrics (Licence: MN 60207) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2024-10-15 |