| NPI | 1760497168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C138320) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301032582) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2018-03-23 |