| NPI | 1154707875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD209159) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 208000000X Pediatrics (Licence: CA A154728) | |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2022-08-11 |