| NPI | 1245791409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 68473) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A178251) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2024-08-13 |