| NPI | 1245685668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 297291) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A177968) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2023-06-12 |