| NPI | 1982046736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A160985) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2013020084) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2019-07-17 |