| NPI | 1811930928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C165562) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR C-6980) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2020-04-28 |