| NPI | 1770591604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C54717) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI PM039179) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2015-01-22 |