| NPI | 1700901337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A85161) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A85161) |
| 208D00000X General Practice (Licence: CA A85161) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-04-07 |