| NPI | 1164916474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 20A21123) |
| Additional Taxonomies | 2080H0002X (Licence: CA 20A21123) |
| 208000000X Pediatrics (Licence: MI 5101024057) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2023-06-07 |