| NPI | 1104355049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD61537259) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A157790) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2024-10-18 |