| NPI | 1285077511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C196295) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR.0071881) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2025-08-06 |