| NPI | 1205867421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: CA G13638) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G13638) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-03-07 |