| NPI | 1821304965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A137111) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.097823) |
| 208000000X Pediatrics (Licence: AR E-8508) | |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2017-03-21 |