| NPI | 1194301119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 184015) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA PTL7140) |
| Enumeration Date | 2021-03-21 |
| Last Update Date | 2024-06-19 |