| NPI | 1902945991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 20A11334) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO 46862) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2015-05-15 |