| NPI | 1932542909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A168695) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 65583-20) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2020-08-05 |