| NPI | 1881663136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C52976) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 201970-1) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2016-03-15 |