| NPI | 1811051691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G52107) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: HI MD-7917) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2022-03-03 |