| NPI | 1093957474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A 118510) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NM RS2009-0296) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2022-01-19 |