| NPI | 1114010725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: GA 78448) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A26103) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: MT MED-PHYS-LIC-91321) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2024-12-30 |