| NPI | 1942403902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 45399) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A92091) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2018-05-01 |