| NPI | 1801964705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G48168) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G48168) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2009-12-18 |