| NPI | 1093249963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A192290) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME159041) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2024-02-06 |