| NPI | 1871599852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD214898) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G89076) |
| 208000000X Pediatrics (Licence: WA MD00028484) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2023-06-20 |