| NPI | 1093707978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A53832) |
| Additional Taxonomies | 173000000X Legal Medicine |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2023-02-28 |