| NPI | 1699902338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A116179) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 27627) |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2015-07-31 |