| NPI | 1235115908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 34744) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A80164) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2026-05-21 |