| NPI | 1043281231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA G027526) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G027526) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2023-03-07 |