| NPI | 1801162789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD186278) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A120054) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2018-03-17 |