| NPI | 1710109657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A108523) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A108523) |
| 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CA A108523) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2023-06-20 |