| NPI | 1235405150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080H0002X (Licence: CA C199571) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C199571) |
| 2080H0002X (Licence: OR MD189088) | |
| Enumeration Date | 2012-03-25 |
| Last Update Date | 2024-12-06 |