| NPI | 1700139508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD195594) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A122284) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2021-03-15 |