| NPI | 1164403929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C51781) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 216995-1) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2021-08-30 |