| NPI | 1215295449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 94597) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 131098) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2023-07-12 |