| NPI | 1053872549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61464031) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A179318) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2026-03-25 |