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 |