| NPI | 1700025780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A 105237) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: GA 063158) |
| 208000000X Pediatrics (Licence: AL 30738) | |
| Enumeration Date | 2009-02-13 |
| Last Update Date | 2021-12-21 |