| NPI | 1174102248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 72493) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A192165) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2026-02-27 |