| NPI | 1033613765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A195452) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MDRE.ML.60865411) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2024-08-21 |