| NPI | 1205367539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 332507) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A169840) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2024-11-13 |