| NPI | 1205255940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A140857) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A140857) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2024-04-10 |